Pediatric Dentistry “Periodontal disease in children: etiology and pathogenesis. Gingivitis, periodontitis and periodontal syndrome in children: prevalence, clinical manifestations, diagnosis, differential diagnosis, treatment and prevention” Lecturer: Dr. Katrin Duda

The periodontal tissues are: Gums (also called gingiva). Gums consist of soft, pink tissue, which covers the alveolar bone. The gum line is where the tooth meets the gum. Bone (alveolar bone). This is the bone in which the roots of teeth are embedded. Periodontal membrane or ligament. This connects and attaches the root of the tooth to the bone.

What is periodontal disease? It is chronic inflammatory disease of the gum and tissues that surround and support the teeth. If left untreated, periodontal disease can lead to tooth loss. This disease divided into two types: Gingivitis Periodontitis

What Are the Symptoms of Gum Disease? Gums that bleed during and after tooth brushing Red, swollen, or tender gums Persistent bad breath or bad taste in the mouth Receding gums Formation of deep pockets between teeth and gums Loose or shifting teeth Changes in the way teeth fit together upon biting down, or in the fit of partial dentures.

Periodontitis “inflammation around the tooth" - it is a serious gum infection that damages the soft tissue and bone that supports the tooth. All periodontal diseases, including periodontitis, are infections which affect the periodontium. The periodontium are the tissues around a tooth, tissues that support the tooth. With periodontitis, the alveolar bone around the teeth is slowly and progressively lost. inflammation.

Periodontitis This is a destructive infection that can affect all the periodontal tissues, that is, the gums, the underlying bone and the connecting tissues. About 20% of adolescents (14-17 years) develop adult periodontitis, but the disease is rare in young children.

What are the risk factors for periodontitis? Hormonal changes in females  Diabetes - patients who live with diabetes have a much higher incidence of gum disease than other individuals of the same age AIDS - people with AIDS have more gum diseases Cancer - and some cancer treatments can make gum diseases more of a problem Some drugs - some medications that reduce saliva are linked to gum disease risk. Genetics - some people are more genetically susceptible to gum diseases

Systemic Factors As Etiologic Agents The possible role of systemic disorders and systemic exposures in initiating or modifying the progression of periodontal disease is a very complex issue. It is however generally agreed that several conditions may give rise to an increase prevalence, incidence or severity of gingivitis and periodontitis

Systemic Factors As Etiologic Agents Microbial plaque is the initiator of periodontal disease but whether it affects a particular subject, what form the disease takes, and how it progresses, are all dependent on the host defenses to this challenge. Systemic factors modify all forms of periodontal disease principally through their effects on the normal immune and inflammatory defenses

Systemic Factors as Etiologic Agents Systemic factors most associated with the etiology and or progression of peritonitis: A. Diabetes Mellitus B. Medications C. Immunosuppressive disorders D. Environmental Conditions or exposures E. Hematological Disorders F. Genetic Disorders.

Classification of Periodontitis 1.    Chronic Periodontitis: a) localized b) generalized 2.    Aggressive Periodontitis: a) localized b) generalized 3.    Periodontitis Associated with Systemic Diseases 4.    Necrotizing Periodontal Diseases 5.    Abscesses of the Periodontium 6.    Periodontal Diseases associated with Endodontic Lesions 7.    Developmental or Acquired Deformities and Conditions

Characteristics of Chronic Periodontitis Most prevalent in adults, but can occur in children and adolescents Amount of destruction is consistent with presence of local factors Subgingival calculus is a frequent finding Associated with a variable microbial pattern Slow to moderate rate of progression but may have periods of rapid progression

Chronic Periodontitis

Characteristics of Aggressive Periodontitis  Patients are otherwise clinically healthy  Rapid attachment loss and bone destruction  Familial aggregation and variable features  Severity of destruction inconsistent with amount of microbial deposts  Elevated proportions of Actinobacillus actinomycetemcomitans and in some patients Porphyromonas gingivalis  Hyper-responsive macrophage phenotype  Progress of bone loss may be self arresting

Early onset periodontitis A small percentage of children (approximately 1%) develop this form of the disease. It is a rapidly developing and very destructive form of periodontitis. It is associated with a blood cell (leucocyte) disorder. The disease may be localized to a few teeth or it may be generalized. It is caused by specific bacteria, and is treated by a combination of antibiotic and surgical therapy.

What causes periodontal disease? Dental plaque is the major cause of gingivitis and periodontitis. The bacteria in the plaque are the major offenders. The effects of plaque can be even more damaging if the patient is in poor health, or has a low resistance to disease. Periodontal disease is unlikely to be transmitted from one person to another.

Diagnosing periodontitis Qualified dentist should find it fairly straightforward to diagnose periodontitis. The dentist will ask the patient questions regarding symptoms and carry out an examination of his/her mouth.

Dental plaque, calculus and tartar Dental plaque is the major cause of gingivitis and periodontitis. The bacteria in the plaque are the major offenders. The effects of plaque can be even more damaging if the patient is in poor health, or has a low resistance to disease. Periodontal disease is unlikely to be transmitted from one person to another.

Healthy Gum pink or coral pink color firm, resilient tissues ”orange-peel” texture shape that follows the contour of the teeth and forms scalloped edge no areas of redness, swelling or inflammation no bleeding during daily plaque removal no discomfort

Healthy Gum

Gingivitis Gingivitis is inflammation of the gum tissue The gums are irritated and swollen due to plaque or calculus buildup along the gum line The gums may be sore, bleed easily and appear puffy, soft and swollen Bleeding gum is one of the earliest and most common sings of gingivitis The good news about gingivitis is that it is preventable and reversible through good brushing and flossing techniques/

Gingivitis

Gingivitis

What Causes Gum Disease? Hormonal changes, such as those occurring during pregnancy, puberty, menopause make gums more sensitive, which makes it easier for gingivitis to develop. Medications can affect oral health, because some lessen the flow of saliva, which has a protective effect on teeth and gums. Bad habits such as smoking make it harder for gum tissue to repair itself. Poor oral hygiene habits such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop. Family history of dental disease can be a contributing factor for the development of gingivitis.

Gum recession

Periodontal disease

Gingivectomy

Thank you for attention